title: Association of osteonecrosis of the jaws and POEMS syndrome in a patient assuming rituximab.
abstract: POEMS syndrome, is a rare condition characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal proteinaemia, and skin lesions. We report a rare case of a patient affected by Waldenström macroglobulinemia, who developed POEMS syndrome and who presented at the time of diagnosis with oral manifestations of the lymphoma and an osteonecrosis of the jaw (ONJ) after rituximab treatment. Although the etiology of ONJ is not known, it is likely that several factors are at play, including endothelial cell damage, decreased angiogenesis, and microvascular compromise. Our patient was treated with rituximab for a long period, and recent studies have demonstrated the possibility that rituximab, a monoclonal antibody directed against the CD20 can exert part of its anti-tumor action, through its action on angiogenesis. Although our report does not allow identification of rituximab as a new risk factor for the onset of the ONJ, further studies seem necessary to exclude a role of the antibody in the alterations of angiogenesis that could lead to the development of the syndrome after rituximab treatment.
authors.affiliation: Division of Hematology, Department of General Surgery and Oncology, AOU Policlinico G. Martino, Via Consolare Valeria, University of Messina, 98185 Messina, Italy. Electronic address: alessandro.allegra@tin.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Allegra
authors.affiliation: Department of Odontostomatology, University of Messina, Messina, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Oteri
authors.affiliation: Division of Hematology, Department of General Surgery and Oncology, AOU Policlinico G. Martino, Via Consolare Valeria, University of Messina, 98185 Messina, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Alonci
authors.affiliation: Hematopathology Section, Department of Hematology and Oncological Sciences, "L. and A. Seràgnoli", S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bacci
authors.affiliation: Division of Hematology, Department of General Surgery and Oncology, AOU Policlinico G. Martino, Via Consolare Valeria, University of Messina, 98185 Messina, Italy.
authors.forename: Giuseppa
authors.initials: G
authors.lastname: Penna
authors.affiliation: Division of Hematology, Department of General Surgery and Oncology, AOU Policlinico G. Martino, Via Consolare Valeria, University of Messina, 98185 Messina, Italy.
authors.forename: Viviana
authors.initials: V
authors.lastname: Minardi
authors.affiliation: Division of Hematology, Department of General Surgery and Oncology, AOU Policlinico G. Martino, Via Consolare Valeria, University of Messina, 98185 Messina, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Maisano
authors.affiliation: Division of Hematology, Department of General Surgery and Oncology, AOU Policlinico G. Martino, Via Consolare Valeria, University of Messina, 98185 Messina, Italy.
authors.forename: Caterina
authors.initials: C
authors.lastname: Musolino
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000209:etiology*; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced; D008339:Mandibular Neoplasms / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D016878:POEMS Syndrome / Q000188:drug therapy / Q000209:etiology*; D000069283:Rituximab; D008258:Waldenstrom Macroglobulinemia / Q000188:drug therapy
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D000069283:Rituximab
keywords: Bevacizumab; Oral manifestation; Osteonecrosis of the jaw; POEMS syndrome; Rituximab; Waldenström macroglobulinemia